Ruxolitinib as a treatment strategy for SARS-CoV-2 pneumonia: clinical experience in a real-world setting.

INTRODUCTION: Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) infection is characterised by a viral phase and a severe pro-inflammatory phase. The inhibition of the JAK/STAT pathway limits the pro-inflammatory state in moderate to severe COVID-19. METHODOLOGY: We analysed the data obtained by an observational cohort of patients with SARS-CoV-2 pneumonia treated with ruxolitinib in 22 hospitals of Mexico. The applied dose was determined based on physician's criteria. The benefit of ruxolitinib was evaluated using the 8-points ordinal scale developed by the NIH in the ACTT1 trial. Duration of hospital stay, changes in pro-inflammatory laboratory values, mortality, and toxicity were also measured. RESULTS: A total of 287 patients were reported at 22 sites in Mexico from March to June 2020; 80.8% received ruxolitinib 5 mg BID and 19.16% received ruxolitinib 10 mg BID plus standard of care. At beginning of treatment, 223 patients were on oxygen support and 59 on invasive ventilation. The percentage of patients on invasive ventilation was 53% in the 10 mg and 13% in the 5 mg cohort. A statistically significant improvement measured as a reduction by 2 points on the 8-point ordinal scale was described (baseline 5.39 ± 0.93, final 3.67± 2.98, p = 0.0001). There were 74 deaths. Serious adverse events were presented in 6.9% of the patients. CONCLUSIONS: Ruxolitinib appears to be safe in COVID-19 patients, with clinical benefits observed in terms of decrease in the 8-point ordinal scale and pro-inflammatory state. Further studies must be done to ensure efficacy against mortality.

Neumonía grave por COVID-19 y administración de medicamentos biológicos

BACKGROUND: In February 2020 World Health Organization (WHO) declared a pandemic for COVID-19 disease (coronavirus disease 2019). In the treatment, the evidence suggests the use of biological medications to counteract the so-called cytochemical storm in order to decrease systemic inflammation and therefore reduce morbidity and mortality. CLINICAL CASES: Six patients (four male, 66.6% and two women, 33.3%) with average age of 58.1 years (range: 41-71) with diagnosis of severe pneumonia due to COVID-19 and the administration of two implied treatments in the cytochemical storm, such as tocilizumab and ruxolitinib. This paper described their clinical evolution in an intensive care unit of a private hospital of Puebla, Puebla. The most important findings were: relieve at 48 hours in the clinical parameters and reduction of inflammation markers after the application of biological drugs. There were not adverse reactions. CONCLUSIONS: The use of tocilizumab, ruxolitinib or both are medications that reduced systemic inflammation in patients with severe pneumonia due to COVID-19. (English) [ABSTRACT FROM AUTHOR] ANTECEDENTES: En febrero de 2020 la Organización Mundial de la Salud (OMS) declaró pandemia por enfermedad COVID-19 (coronavirus disease 2019). En el tratamiento la evidencia sugiere la administración de medicamentos biológicos para contrarrestar la llamada tormenta citoquímica con la finalidad de disminuir la inflamación sistémica y, por consiguiente, reducir la morbilidad y mortalidad. CASOS CLÍNICOS: Seis pacientes (4 varones, 66.6% y 2 mujeres, 33.3%) con promedio de edad de 58.1 años (intervalo: 41-71) con diagnóstico de neumonía grave por COVID-19 y administración de dos tratamientos implicados en la tormenta citoquímica, como tocilizumab y ruxolitinib. Se describe su evolución clínica en una unidad de terapia intensiva de un hospital privado de la ciudad de Puebla, Puebla. Los hallazgos más importantes fueron: mejoría a las 48 horas en los parámetros clínicos y disminución de los marcadores de inflamación tras la aplicación de los biológicos. No se obtuvieron reacciones adversas. CONCLUSIONES: Tocilizumab, ruxolitinib o ambos son medicamentos que alivian la inflamación sistémica en los pacientes con neumonía grave por COVID-19. (Spanish) [ABSTRACT FROM AUTHOR] Copyright of Medicina Interna de Mexico is the property of Colegio de Medicina Interna de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)